The nurse is assessing the client 1 hour after a cardiac catheterization through the right femoral artery. Which is the best parameter for the nurse to use for early detection of thromboembolic complications in the affected foot?

Question

1. Ankle-brachial index
2. Right posterior tibial pulse
3. Pulse pressure in left lower extremity
4. Doppler imaging of right femoral artery

Answer 1

2
2. The nurse monitors the client's right posterior tibial pulse to assess a distal aspect of the affected leg to determine adequacy of blood flow beyond the insertion site of the cardiac catheter. The femoral artery is opened and the interventional cardiologist feeds a cardiac catheter through the opening. At the completion of the procedure, the opening is surgically closed and the nurse applies sustained pressure to the site to prevent bleeding from the femoral artery because blood loss from a major artery is potentially catastrophic. Still, the client risks thromboembolic complications as the blood clots and the femoral artery heals; if a thrombus embolizes, the client loses blood flow to the leg. By monitoring the distal pulses, the nurse quickly detects a di-minished pulse or cool, pale skin potentially indicating impaired perfusion. As a re-sult, the nurse notifies the provider to collaborate for additional care.
1. The ankle-brachial index is a reasonable method of assessing perfusion to the ex-tremity but is not commonly used after cardiac catheterization because of throm-boembolic risks of the procedure.
3. Pulse pressures are not valuable to evaluate peripheral perfusion because the pulse pressure is the difference between the systolic and diastolic blood pressures.
4. The nurse can assess the right femoral artery before the procedure to establish baseline data for comparison after the procedure; however, the nurse monitors peri-pheral circulation (post. tibial) for early detection of impaired circulation in the af-fected leg. If perfusion to the extremity becomes impaired, the nurse works toward the femoral pulse to locate perfused tissue with a palpable pulse.